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OHSU Research Shows Significant Improvements In Care Of Dying Oregonians

06/13/06 Portland, Ore.

The soon-to-be-published research reveals how specialized teams of physicians and nurses can help fulfill patient wishes to spend their last days away from the hospital.

Only 5 percent of discharged patients who consulted with OHSU Hospital's palliative care team needed to be readmitted to an acute care hospital to die. Because the palliative care team was able to predict patients' life expectancy and needs, the team was able to develop treatment plans that allowed patients to spend their last days in their preferred setting. These significant findings were the result of an OHSU study published in an upcoming edition of the Journal of Palliative Medicine. The study is the first of its kind to track patients receiving palliative care consultation after hospital discharge. Major findings of this study will be presented approximately two months ahead of the publication date at a statewide meeting of palliative care leaders on Friday, June 16.

Charles Von Gunten, M.D., Ph.D., one of the founding fathers of palliative medicine, will be the keynote speaker of the statewide meeting: Palliative Care in Oregon - Looking Toward the Future. Von Gunten is the editor of the Journal of Palliative Medicine and directs the Center for Palliative Studies at San Diego Hospice.

"No one has done more to establish palliative medicine as a recognized medical specialty in the past five years than Charles Von Gunten," said Erik Fromme, M.D., chairman of the statewide meeting. This meeting has sold out for the second consecutive year and will be attended by palliative care experts representing every hospital-based palliative care team in Oregon and southwest Washington.

"Palliative care teams are a relatively new development, but they are becoming increasingly popular in the United States," explained Fromme, who is also lead author of the study and a member of OHSU's Palliative Medicine and Comfort Care Team. "Approximately 1,200 hospitals nationwide have established teams. We believe that every patient with life-limiting illness in Oregon should have access to high-quality palliative care services."

Typically, palliative care teams include specialized doctors, nurses, social workers and chaplains. The teams assess patients' symptoms, their prognosis and care goals, their wishes, and their family and support systems. The teams then use this data to develop a care plan, which frequently includes a plan for care after hospital discharge for patients who no longer wish to be in the hospital. Previous research demonstrates that most patients, if given the choice, prefer to die in a non-hospital setting and in as much comfort as possible.

"This study shows that palliative care teams are an effective method for ensuring that patients' final wishes are met," explained Fromme.

"One common example is a patient with advanced chronic disease who is being cared for by an elderly spouse," explained Susan Tolle, M.D., a co-author of the study and director of the OHSU Center for Ethics in Health Care. "In a case such as this, the team would likely conclude that the patient's needs are greater than what a single, aging family member is able to provide. The team would then devise a plan that provides additional home assistance and support. Of course in order for this to take place, certain support services such as home hospice need to be available to the patient."

To conduct this study, OHSU reviewed 292 cases in which patients consulted with the OHSU palliative care team during a one-year period. The patients were also tracked upon their departure from the hospital and information about the location of their deaths was gathered from death certificates. Of the patients studied, almost two-thirds were discharged alive from the hospital and nearly all were successfully cared for in a community setting. In fact, only 5 percent died in acute care hospitals.

"The 5 percent rate of re-hospitalization for patients who chose an out-of-hospital setting says a lot about the effectiveness of discharge planning and pain management," explained Tolle. "This research also provides many important lessons for future generations of health care providers. OHSU's newly established Miles J. Edwards Chair in Professionalism and Comfort Care is specifically geared toward improving palliative care through education. This study will be used in the new program and also serves as evidence that palliative care education is incredibly important."

This research also paints an interesting picture when viewed in the context of national data recently released in the highly respected Dartmouth Atlas of Health Care.

"The Dartmouth Atlas reveals that in most cases, a patient's health trajectory can be predicted - their past helps predict their future," said Fromme. "However, as the Oregon research shows, this trajectory can be significantly altered through palliative care planning and through the existence of programs and support services in the community. "